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Pharmacology > Immunosuppression > Flashcards

Immunosuppression Flashcards

1
Q

What drugs are used as immunosuppressants?

A 
Corticosteroids
Methotrexate
Azathioprine
Ciclosporin 
Tacrolimus 
Mycophenolate mofetil 
Cyclophosphamide
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2
Q

What is the mechanism of corticosteroids?

A

Prevent IL-1 + IL-6 production by macrophages

Inhibit all stages of T-cell activation

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3
Q

What drugs are DMARDs?

A 
Sulphasalazine 
Hydroxychloroquine
Anti-TNF agents
Rituximab 
IL-6 inhibitors 
JAK inhibitors
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4
Q

What is methotrexate?

A

Anti-metabolite

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5
Q

What are the indications for methotrexate?

A

RA
Crohn’s
Psoriasis
Malignancy

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6
Q

What is the route of administration of methotrexate?

A

Oral
IM
SC
IV

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7
Q

What is the mechanism of action of methotrexate?

A

Inhibits dihydrofolate reductase

Reduces synthesis of purines + pyrimidines
Inhibit accumulation of adenosine
Inhibit T-cell activation

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8
Q

What are the side effects of methotrexate?

A 
Mucositis 
Marrow suppression 
Hepatitis 
Pneumonitis 
Increased infection risk

Teratogenic

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9
Q

What is azathioprine?

A

Antiproliferative immunosuppressant

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10
Q

What are the indications for azathioprine?

A 
Crohn's 
UC
RA
SLE
Suppress transplant rejection
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11
Q

What are the routes of administration of azathioprine?

A

Oral

IV

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12
Q

What is the mechanism of azathioprine?

A

Cleaved to 6-MP

Inhibits DNA/RNA synthesis

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13
Q

What are the side effects of azathioprine?

A 
Bone marrow suppression 
Increased risk of malignancy 
Increased infection risk 
Hepatitis 
Thrombocytopenia
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14
Q

What is ciclosporin?

A

Calcineurin inhibitor

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15
Q

What are the indications for ciclosporin?

A 
UC
RA
Atopic dermatitis 
Psoriasis 
Transplantation
Nephrotic syndrome
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16
Q

What are the routes of administration of ciclosporin?

A

Oral

IV

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17
Q

What is the mechanism of ciclosporin?

A

Inhibits calcineurin - binds to cyclophilin protein

Prevents production of IL-2

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18
Q

What are the side effects of ciclosporin?

A 
Eye inflammation 
D+V
Fever
Fatigue 
Hepatic dysfunction
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19
Q

What is tacrolimus?

A

Calcineurin inhibitor

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20
Q

What are the indications for tacrolimus

A

Eczema
Psoriasis
Transplant

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21
Q

What are the routes of administration for tacrolimus?

A

Topical
Oral
IV

22
Q

What is the mechanism of tacrolimus?

A

Inhibits calcineurin - binds to tacrolimus-binding protein

Prevents production of IL-2

23
Q

What are the side effects of tacrolimus?

A

Infection risk
Abnormal sensation
Skin reactions

24
Q

What is mycophenolate mofetil?

A

Antiproliferative immunosuppressant

25
Q

What are the indications for mycophenolate mofetil?

A

Transplant

26
Q

What are the routes of administration of mycophenolate mofetil?

27
Q

What is the mechanism of mycophenolate mofetil?

A

Inhibits inosine monophosphate dehydrogenase - required for guanosine synthesis

Impairs B + T cell proliferation

28
Q

What are the side effects of mycophenolate mofetil?

A

Nausea
D+V
Myelosuppression

29
Q

What is cyclophosphamide?

A

Cytotoxic agent

30
Q

What are the indications for cyclophosphamide?

A 
RA
Leukaemia
Lymphoma
Solid cancers 
Lupus nephritis 
ANCA vasculitis
31
Q

What is the route of administration of cyclophosphamide?

32
Q

What is the mechanism of cyclophosphamide?

A

Alkylating agent - cross links DNA

Suppresses T-cell activity
Suppresses B-cell activity

33
Q

What are the side effects of cyclophosphamide?

A

Bone marrow suppression

Fever

34
Q

What is sulphasalazine?

A

Amino salicylate

35
Q

What are the indications for sulphasalazine?

A

UC
Crohn’s
RA

36
Q

What are the routes of administration of sulphasalazine?

A

Oral

Per rectum

37
Q

What is the mechanism of sulphasalazine?

A

T cell

  • inhibit proliferation
  • inhibit IL-2 production

Neutrophil

  • reduced chemotaxis
  • reduced degranulation
38
Q

What are the side effects of sulphasalazine?

A 
Myelosuppression 
Hepatitis 
Rash 
Nausea 
Vomiting 
Abdo pain
39
Q

What monoclonal antibodies are used for immunosuppression?

A

Rituximab
Infliximab
Adalimumab

40
Q

What are the indications for rituximab?

A

RA

Lymphoma

41
Q

What is the route of administration of rituximab?

42
Q

What is the mechanism of rituximab?

A

Binds to unique cell marker CD20 on B cells - causes B cell apoptosis

43
Q

What are the side effects of rituximab?

A

Fever
Hypersensitivity
Infection risk

44
Q

What are the indications for infliximab?

A 
Crohn's
UC
RA
AS
Psoriatic arthritis
45
Q

What is the route of administration of infliximab?

46
Q

What is the mechanism of infliximab?

A

TNF-α inhibitor

  • reduces inflammation
  • reduces joint destruction
47
Q

What are the side effects of infliximab?

A

Fatigue
GI disorders infection risk
Myalgia

48
Q

What are the indications for adalimumab?

A 
RA
Psoriatic arthritis 
AS
Crohn's
UC
49
Q

What is the route of administration of adalimumab?

50
Q

What is the mechanism of adalimumab?

A

TNF-α inhibitor

  • reduces inflammation
  • reduces joint destruction
51
Q

What are the side effects of adalimumab?

A 
Pain/swelling at injection site
Infection risk 
Headache 
Nausea
Rash

Pharmacology (27 decks)

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